Health Systems 20/20 Caribbean: Third Quarter Report

The program's purpose is to support governments in strengthening their health financing systems for a sustainable HIV/AIDS response in the Caribbean. The Health Systems 20/20 Caribbean project is implemented by Abt Associates Inc. and funded by the United States Agency for International Development (USAID), under the Cooperative Agreement # AID-538-LA-12-00001. The project aims to build improved health financing capacity and leadership to ensure long-term financial sustainability of health and HIV programs in the Eastern Caribbean. Abt has partnered with the HEU, Centre for Health Economics of the University of the West Indies (UWI-HEU) to further develop UWI-HEU's capacity to provide health financing technical assistance in the region. The project's vision is to build country capacity in core health system components – financing, governance, and operations – enabling health systems to function more sustainably and efficiently while maintaining attention to disease-specific priorities. The expected outcomes of HS20/20 Caribbean are increased use of health and HIV expenditure data and unit cost information to inform resource allocation decisions, health sector reforms, financial sustainability planning, and advocacy. Strengthened Ministry of Health (MOH) financial management capacity, including the ability to conduct costing analyses and utilize costing data for strategic and operational planning, is also an expected outcome. Additionally, the project aims to strengthen regional institutional capacity to provide health financing technical assistance, specifically in National Health Accounts (NHA), and HIV subaccounts. Progress toward coverage of HIV/AIDS services by public and private health insurance is also a key objective. During the third quarter, the HS20/20 team completed the analysis and report writing for the Antigua and Barbuda Costing of Service Provision at the Mount St. John's Medical Center in Antigua and Barbuda. The study found that in 2012, people living with HIV (PLHIV) had an average length of stay of 16 days, representing 1.5 percent of all MSJMC inpatient admissions and 4.5 percent of all bed/patient-days for that year. Inpatient care costs for these patients amounted to a total of EC$1.2 million or US$456,000, which was 2.5 percent of all MSJMC recurrent costs. The estimated average cost per PLHIV inpatient admission was EC$14,671 (US$5,434), implying almost a three-fold higher per-patient cost than the MSJMC inpatient average of EC$4,893 (US$1,812). In April 2013, the project received approval from the National Human Research Ethics Committee of the Dominica MOH to conduct the national household health expenditure survey and PLHIV health expenditure survey in Dominica. However, the Dominica Central Statistics Office (CSO) indicated that the research approval could not be considered final given that the CSO was not included in the approval process. The CSO approved the implementation of the PLHIV survey but determined that the general household survey is subject to Dominica's Census and Statistics Act of 1986, which stipulates that participation in all nationally-representative surveys is mandatory. The project faced a legal impasse at the end of the third quarter due to this issue.